| NPI | 1134658743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 73227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10888) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2018012279) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-06-21 |